Migration, Acculturation, and Sexual and Reproductive Health of Latino Adolescents

Abstract

See Related Article p. 14Latinos are the fastest growing demographic group in the United States, as a result of considerable recent immigration and fertility. Latinos are the largest ethnic minority group in the United States and one of the youngest. By 2025, 24% of U.S. youth will be Latino, up from 15% in 2000 [[1]Guzman B. The Hispanic population in the United States: Population characteristics. Current Population Reports, P2–535 2001. In press. Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf. Accessed November 27, 2004.Google Scholar]. One-half (52%) of the total foreign-born population in 2000 was composed of Latino immigrants [[2]Malone N, Baluja K, Costanzo J, et al. The foreign born population: 2000. Census 2000 Brief 2003. Available at: http://www.census.gov/prod/2003pubs/c2kbr-34.pdf. Accessed November 27, 2004.Google Scholar]. Two-thirds (65%) of Latino high school students are the children of at least one immigrant parent and 24% are foreign-born themselves [[3]Shin H. School enrollment in the United States: Social and economic characteristics of students: October 2003. Current Population Reports 2005; Available at: http://www.census.gov/prod/2005pubs/p20-554.pdf. Accessed September 29, 2008.Google Scholar]. However, the “Latino” category combines many different groups, including Mexicans (59% of Latinos), (mainland) Puerto Ricans (10%), Cubans (3.5%), Central Americans (4.8%), South Americans (3.8%), Dominicans (2.2%), and Spaniards (0.3%) [[1]Guzman B. The Hispanic population in the United States: Population characteristics. Current Population Reports, P2–535 2001. In press. Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf. Accessed November 27, 2004.Google Scholar].Latinos in the U.S. differ in sociodemographic factors (e.g., age and social class), place of birth (e.g., native- vs. foreign-born status), and connection to country of origin. Some of these differences directly relate to sociopolitical forces that drive “push” and “pull” factors in immigration. For example, fleeing the Castro regime, Cubans largely immigrated in waves; the earliest wave (1959–1965) tended to be white and middle to upper class (the targets of Castro's wealth redistribution campaigns), whereas subsequent waves were more diverse. In contrast, Mexicans immigrated to the U.S. at a steadier pace, at higher rates, and for various reasons (civil war, temporary labor agreements with the U.S., and economic instability), and many southwestern U.S. Mexican-Americans are native-born descendants of residents whose territory was annexed to the U.S. in the mid 1880s. Puerto Ricans are not immigrants but U.S. citizens, a direct consequence of the Spanish-American War when Spain ceded Puerto Rico (which remains a U.S. commonwealth) to the United States in 1899. Due, in part, to these historical trajectories, Cubans, relative to Mexicans, Puerto Ricans, and Central and South Americans, are older [[1]Guzman B. The Hispanic population in the United States: Population characteristics. Current Population Reports, P2–535 2001. In press. Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf. Accessed November 27, 2004.Google Scholar], have a higher level of education and a smaller percentage of families living below the poverty level [[4]Therrien M, Ramirez R. The Hispanic Population in the United States: Population Characteristics. Current Population Reports, P20–535 2000 [cited November 27, 2004]; Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf.Google Scholar], and experience greater restrictions accessing their country of origin. Despite these differences, public health data in the U.S. are seldom stratified by national origin.Latino youth in the U.S. face considerable challenges to their sexual and reproductive health: unplanned pregnancy and sexually transmitted infections, including HIV. Higher fertility among Latino adolescents reflects, in part, fertility patterns in sending communities of Latin America. However, Latinos in the U.S. also experienced the smallest recent declines in teen pregnancy and teen birth rates among the major demographic subgroups (i.e., Hispanics and non-Hispanic whites and blacks) tracked in U.S. public health statistics [[5]Ventura S.J. Abma J. Mosher W. et al.Estimated pregnancy rates by outcome for the United States, 1990–2004. National Vital Statistics Report. 2008; 56: 1-28Google Scholar]. Given these trends, the Latino teen birth rate now exceeds the rate for African-American teens, the group that has historically had the highest teen fertility rate. Correspondingly, Latino youth have shown some of the smallest improvements in teen sexual behaviors tracked in national health surveys such as the Youth Risk Behavior Survey (YRBS). From 1991 to 2007, Latino high school students showed no change in rates of sexual experience (53% to 52%) or in lifetime multiple partners (17% and 17%), despite declines among African-Americans and whites [[6]Balaji A. Lowry R. Brener N. et al.Trends in HIV- and STD-related risk behaviors among high school students—United States 1991–2007.MMWR. 2008; 57: 817-822PubMed Google Scholar]. Latino high school students have shown improvements in condom use [[6]Balaji A. Lowry R. Brener N. et al.Trends in HIV- and STD-related risk behaviors among high school students—United States 1991–2007.MMWR. 2008; 57: 817-822PubMed Google Scholar], and not-yet-reported YRBS data seem to indicate that Latino high school students have also shown improvement in contraceptive use that is similar to that of other demographic groups. However, these same data, currently under analysis, suggest that throughout this time period, Latino students have been less likely to use the pill and more likely to be nonusers compared with white students.The paper by McDonald and colleagues [[7]McDonald J.A. Manlove J. Ikramullah E.N. Immigration measures and reproductive health among Hispanic youth: Findings from the National Longitudinal Survey of Youth, 1997–2003.J Adolesc Health. 2009; 44: 14-24Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar] in this issue of the Journal provides important new information about reproductive health among Latino youth, focusing on differences based on national original and on acculturation. This study displays important strengths such as use of a longitudinal, national population–based cohort and comparison of behaviors by national origin. The investigators document important differences in adolescent sexual and reproductive health behaviors, including sexual experience and current contraceptive use. Importantly, the authors found health behavior differences among Mexican, Puerto Rican, Cuban, and other Central and South American youth. With increasing generational status, and as English becomes predominant at home (two key markers of acculturation), Latino teens experienced an earlier age at first sex and became more likely to use contraceptives. In essence, with acculturation, behaviors of Latino teens come to more closely resemble those of non-Latino U.S. teens. These findings reinforce previous studies that found acculturation among Latino youth is associated with earlier sexual initiation and improved condom use [[8]Afable-Munsuz A. Brindis C.D. Acculturation and the sexual and reproductive health of Latino youth in the United States: A literature review.Perspect Sex Reprod Health. 2006; 38: 208-219Crossref PubMed Scopus (133) Google Scholar].Latino youth may face social influences and life choices that differ markedly from those faced by their parents [[9]Biggs MA, Brindis CD, Ralph L, Santelli J. The sexual and reproductive health of young Latino males living in the U.S. In: Aguirre-Molina M, Borrell L, Vega W, eds. The Social & Structural Factors Affecting the Health of Latino Men. Piscataway, New Jersey: Rutgers University Press. In press.Google Scholar]. Understanding the process of acculturation may help us understand disparities in the sexual and reproductive health of Latino youth. Acculturation can be defined broadly as the process by which immigrants adopt the attitudes, values, customs, beliefs, and behavior of a new culture [10Clark L. Hofsess L. Acculturation.in: Loue S. Handbook of Immigrant Health. Plenum Press, New York, NY1998: 37-59Crossref Google Scholar, 11Chun K. Organista P. Marin G. Acculturation: Advances in Theory, Measurement, and Applied Research. American Psychological Association, Washington, DC2003Crossref Google Scholar], all of which may affect health. Moreover, culturally based beliefs, values, and behaviors, as well as structural constraints, can interact to influence health. Yet basic questions concerning the mechanisms and processes by which acculturation affects health have not been addressed [[12]Abraido-Lanza A. Armbrister A. Florez K. et al.Toward a theory-driven model of acculturation in public health research.Am J Public Health. 2006; 96: 1342-1346Crossref PubMed Scopus (502) Google Scholar]. For example, although it is assumed that beliefs or norms concerning particular behaviors (e.g., sexual practices) change with greater acculturation—and that immigrants “bring” these norms and values from their countries of origin—these underlying assumptions are rarely tested. Furthermore, normative belief systems are not well articulated, and their associations with health are not fully explored. Further hampering our understanding of the association between acculturation and health, despite its complexity, acculturation has been measured with rather simple indices such as language spoken at home, length of time in the U.S., and generation status (e.g., first vs. second vs. third generation) [[13]Zane N. Mak W. Major approaches to the measurement of acculturation among ethnic minority populations: A content analysis and alternative empirical strategy.in: Chun K. Organista P. Marin G. Acculturation: Advances in Theory, Measurement, and Applied Research. American Psychological Association, Washington, DC2003: 39-60Crossref Google Scholar].Acculturation can be associated with both protective and risky health behaviors among adults and adolescents. For example, the “healthy immigrant” effect is based on the observation that first-generation Mexican immigrants may experience better birth outcomes compared with the second and third generations, despite lower socioeconomic status [[14]Guendelman S. Gould J.B. Hudes M. et al.Generational differences in perinatal health among the Mexican American population: Findings from HHANES 1982–84.Am J Public Health. 1990; 80: 61-65Crossref PubMed Google Scholar]. McDonald and colleagues [[7]McDonald J.A. Manlove J. Ikramullah E.N. Immigration measures and reproductive health among Hispanic youth: Findings from the National Longitudinal Survey of Youth, 1997–2003.J Adolesc Health. 2009; 44: 14-24Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar] and others [8Afable-Munsuz A. Brindis C.D. Acculturation and the sexual and reproductive health of Latino youth in the United States: A literature review.Perspect Sex Reprod Health. 2006; 38: 208-219Crossref PubMed Scopus (133) Google Scholar, 9Biggs MA, Brindis CD, Ralph L, Santelli J. The sexual and reproductive health of young Latino males living in the U.S. In: Aguirre-Molina M, Borrell L, Vega W, eds. The Social & Structural Factors Affecting the Health of Latino Men. Piscataway, New Jersey: Rutgers University Press. In press.Google Scholar] note both positive and negative trends: earlier sexual debut but improved contraceptive use. Certain aspects of Latino culture, such as the importance of strong family ties (familismo), support healthy sexual and reproductive development among youth. Other cultural structures such as machismo may be less supportive of reproductive health. The extent to which these values and norms predict sexual practices have not been explored fully.Migration to the U.S. at the dawn of 21st century is qualitatively different from the “Ellis Island” wave of immigration at the beginning of the 20th century. Increasingly, migration is circular, and migrants (including adolescents) live in “transnational” communities [[15]Roberts B.R. Frank R. Lozano-Ascencio F. Transnational migrant communities and Mexican migration to the US.Ethn Racial Studies. 1999; 22: 238-266Crossref Scopus (149) Google Scholar], moving back and forth between “sending” and “receiving” communities and challenging previous thinking about unidirectional acculturation. These migration streams will have important and perhaps unpredictable consequences for adolescent health. Time will tell how Latino cultures have enriched and created new challenges for adolescent health in the U.S. See Related Article p. 14 See Related Article p. 14 See Related Article p. 14 Latinos are the fastest growing demographic group in the United States, as a result of considerable recent immigration and fertility. Latinos are the largest ethnic minority group in the United States and one of the youngest. By 2025, 24% of U.S. youth will be Latino, up from 15% in 2000 [[1]Guzman B. The Hispanic population in the United States: Population characteristics. Current Population Reports, P2–535 2001. In press. Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf. Accessed November 27, 2004.Google Scholar]. One-half (52%) of the total foreign-born population in 2000 was composed of Latino immigrants [[2]Malone N, Baluja K, Costanzo J, et al. The foreign born population: 2000. Census 2000 Brief 2003. Available at: http://www.census.gov/prod/2003pubs/c2kbr-34.pdf. Accessed November 27, 2004.Google Scholar]. Two-thirds (65%) of Latino high school students are the children of at least one immigrant parent and 24% are foreign-born themselves [[3]Shin H. School enrollment in the United States: Social and economic characteristics of students: October 2003. Current Population Reports 2005; Available at: http://www.census.gov/prod/2005pubs/p20-554.pdf. Accessed September 29, 2008.Google Scholar]. However, the “Latino” category combines many different groups, including Mexicans (59% of Latinos), (mainland) Puerto Ricans (10%), Cubans (3.5%), Central Americans (4.8%), South Americans (3.8%), Dominicans (2.2%), and Spaniards (0.3%) [[1]Guzman B. The Hispanic population in the United States: Population characteristics. Current Population Reports, P2–535 2001. In press. Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf. Accessed November 27, 2004.Google Scholar]. Latinos in the U.S. differ in sociodemographic factors (e.g., age and social class), place of birth (e.g., native- vs. foreign-born status), and connection to country of origin. Some of these differences directly relate to sociopolitical forces that drive “push” and “pull” factors in immigration. For example, fleeing the Castro regime, Cubans largely immigrated in waves; the earliest wave (1959–1965) tended to be white and middle to upper class (the targets of Castro's wealth redistribution campaigns), whereas subsequent waves were more diverse. In contrast, Mexicans immigrated to the U.S. at a steadier pace, at higher rates, and for various reasons (civil war, temporary labor agreements with the U.S., and economic instability), and many southwestern U.S. Mexican-Americans are native-born descendants of residents whose territory was annexed to the U.S. in the mid 1880s. Puerto Ricans are not immigrants but U.S. citizens, a direct consequence of the Spanish-American War when Spain ceded Puerto Rico (which remains a U.S. commonwealth) to the United States in 1899. Due, in part, to these historical trajectories, Cubans, relative to Mexicans, Puerto Ricans, and Central and South Americans, are older [[1]Guzman B. The Hispanic population in the United States: Population characteristics. Current Population Reports, P2–535 2001. In press. Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf. Accessed November 27, 2004.Google Scholar], have a higher level of education and a smaller percentage of families living below the poverty level [[4]Therrien M, Ramirez R. The Hispanic Population in the United States: Population Characteristics. Current Population Reports, P20–535 2000 [cited November 27, 2004]; Available at: http://www.census.gov/population/socdemo/hispanic/p20-535/p20-535.pdf.Google Scholar], and experience greater restrictions accessing their country of origin. Despite these differences, public health data in the U.S. are seldom stratified by national origin. Latino youth in the U.S. face considerable challenges to their sexual and reproductive health: unplanned pregnancy and sexually transmitted infections, including HIV. Higher fertility among Latino adolescents reflects, in part, fertility patterns in sending communities of Latin America. However, Latinos in the U.S. also experienced the smallest recent declines in teen pregnancy and teen birth rates among the major demographic subgroups (i.e., Hispanics and non-Hispanic whites and blacks) tracked in U.S. public health statistics [[5]Ventura S.J. Abma J. Mosher W. et al.Estimated pregnancy rates by outcome for the United States, 1990–2004. National Vital Statistics Report. 2008; 56: 1-28Google Scholar]. Given these trends, the Latino teen birth rate now exceeds the rate for African-American teens, the group that has historically had the highest teen fertility rate. Correspondingly, Latino youth have shown some of the smallest improvements in teen sexual behaviors tracked in national health surveys such as the Youth Risk Behavior Survey (YRBS). From 1991 to 2007, Latino high school students showed no change in rates of sexual experience (53% to 52%) or in lifetime multiple partners (17% and 17%), despite declines among African-Americans and whites [[6]Balaji A. Lowry R. Brener N. et al.Trends in HIV- and STD-related risk behaviors among high school students—United States 1991–2007.MMWR. 2008; 57: 817-822PubMed Google Scholar]. Latino high school students have shown improvements in condom use [[6]Balaji A. Lowry R. Brener N. et al.Trends in HIV- and STD-related risk behaviors among high school students—United States 1991–2007.MMWR. 2008; 57: 817-822PubMed Google Scholar], and not-yet-reported YRBS data seem to indicate that Latino high school students have also shown improvement in contraceptive use that is similar to that of other demographic groups. However, these same data, currently under analysis, suggest that throughout this time period, Latino students have been less likely to use the pill and more likely to be nonusers compared with white students. The paper by McDonald and colleagues [[7]McDonald J.A. Manlove J. Ikramullah E.N. Immigration measures and reproductive health among Hispanic youth: Findings from the National Longitudinal Survey of Youth, 1997–2003.J Adolesc Health. 2009; 44: 14-24Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar] in this issue of the Journal provides important new information about reproductive health among Latino youth, focusing on differences based on national original and on acculturation. This study displays important strengths such as use of a longitudinal, national population–based cohort and comparison of behaviors by national origin. The investigators document important differences in adolescent sexual and reproductive health behaviors, including sexual experience and current contraceptive use. Importantly, the authors found health behavior differences among Mexican, Puerto Rican, Cuban, and other Central and South American youth. With increasing generational status, and as English becomes predominant at home (two key markers of acculturation), Latino teens experienced an earlier age at first sex and became more likely to use contraceptives. In essence, with acculturation, behaviors of Latino teens come to more closely resemble those of non-Latino U.S. teens. These findings reinforce previous studies that found acculturation among Latino youth is associated with earlier sexual initiation and improved condom use [[8]Afable-Munsuz A. Brindis C.D. Acculturation and the sexual and reproductive health of Latino youth in the United States: A literature review.Perspect Sex Reprod Health. 2006; 38: 208-219Crossref PubMed Scopus (133) Google Scholar]. Latino youth may face social influences and life choices that differ markedly from those faced by their parents [[9]Biggs MA, Brindis CD, Ralph L, Santelli J. The sexual and reproductive health of young Latino males living in the U.S. In: Aguirre-Molina M, Borrell L, Vega W, eds. The Social & Structural Factors Affecting the Health of Latino Men. Piscataway, New Jersey: Rutgers University Press. In press.Google Scholar]. Understanding the process of acculturation may help us understand disparities in the sexual and reproductive health of Latino youth. Acculturation can be defined broadly as the process by which immigrants adopt the attitudes, values, customs, beliefs, and behavior of a new culture [10Clark L. Hofsess L. Acculturation.in: Loue S. Handbook of Immigrant Health. Plenum Press, New York, NY1998: 37-59Crossref Google Scholar, 11Chun K. Organista P. Marin G. Acculturation: Advances in Theory, Measurement, and Applied Research. American Psychological Association, Washington, DC2003Crossref Google Scholar], all of which may affect health. Moreover, culturally based beliefs, values, and behaviors, as well as structural constraints, can interact to influence health. Yet basic questions concerning the mechanisms and processes by which acculturation affects health have not been addressed [[12]Abraido-Lanza A. Armbrister A. Florez K. et al.Toward a theory-driven model of acculturation in public health research.Am J Public Health. 2006; 96: 1342-1346Crossref PubMed Scopus (502) Google Scholar]. For example, although it is assumed that beliefs or norms concerning particular behaviors (e.g., sexual practices) change with greater acculturation—and that immigrants “bring” these norms and values from their countries of origin—these underlying assumptions are rarely tested. Furthermore, normative belief systems are not well articulated, and their associations with health are not fully explored. Further hampering our understanding of the association between acculturation and health, despite its complexity, acculturation has been measured with rather simple indices such as language spoken at home, length of time in the U.S., and generation status (e.g., first vs. second vs. third generation) [[13]Zane N. Mak W. Major approaches to the measurement of acculturation among ethnic minority populations: A content analysis and alternative empirical strategy.in: Chun K. Organista P. Marin G. Acculturation: Advances in Theory, Measurement, and Applied Research. American Psychological Association, Washington, DC2003: 39-60Crossref Google Scholar]. Acculturation can be associated with both protective and risky health behaviors among adults and adolescents. For example, the “healthy immigrant” effect is based on the observation that first-generation Mexican immigrants may experience better birth outcomes compared with the second and third generations, despite lower socioeconomic status [[14]Guendelman S. Gould J.B. Hudes M. et al.Generational differences in perinatal health among the Mexican American population: Findings from HHANES 1982–84.Am J Public Health. 1990; 80: 61-65Crossref PubMed Google Scholar]. McDonald and colleagues [[7]McDonald J.A. Manlove J. Ikramullah E.N. Immigration measures and reproductive health among Hispanic youth: Findings from the National Longitudinal Survey of Youth, 1997–2003.J Adolesc Health. 2009; 44: 14-24Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar] and others [8Afable-Munsuz A. Brindis C.D. Acculturation and the sexual and reproductive health of Latino youth in the United States: A literature review.Perspect Sex Reprod Health. 2006; 38: 208-219Crossref PubMed Scopus (133) Google Scholar, 9Biggs MA, Brindis CD, Ralph L, Santelli J. The sexual and reproductive health of young Latino males living in the U.S. In: Aguirre-Molina M, Borrell L, Vega W, eds. The Social & Structural Factors Affecting the Health of Latino Men. Piscataway, New Jersey: Rutgers University Press. In press.Google Scholar] note both positive and negative trends: earlier sexual debut but improved contraceptive use. Certain aspects of Latino culture, such as the importance of strong family ties (familismo), support healthy sexual and reproductive development among youth. Other cultural structures such as machismo may be less supportive of reproductive health. The extent to which these values and norms predict sexual practices have not been explored fully. Migration to the U.S. at the dawn of 21st century is qualitatively different from the “Ellis Island” wave of immigration at the beginning of the 20th century. Increasingly, migration is circular, and migrants (including adolescents) live in “transnational” communities [[15]Roberts B.R. Frank R. Lozano-Ascencio F. Transnational migrant communities and Mexican migration to the US.Ethn Racial Studies. 1999; 22: 238-266Crossref Scopus (149) Google Scholar], moving back and forth between “sending” and “receiving” communities and challenging previous thinking about unidirectional acculturation. These migration streams will have important and perhaps unpredictable consequences for adolescent health. Time will tell how Latino cultures have enriched and created new challenges for adolescent health in the U.S.